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Akakpo PK, Imbeah EG, Edusei L, Naporo S, Ulzen-Appiah K, Clegg-Lamptey JN, Dedey F, Nsaful J, Affram N, Wiafe B, Mensah S, Nortey M, Sheriff M, Amponsah-Manu F, Agbedinu K, Jiagge EM. Clinicopathologic characteristics of early-onset breast cancer: a comparative analysis of cases from across Ghana. BMC Womens Health 2023; 23:5. [PMID: 36597014 PMCID: PMC9808934 DOI: 10.1186/s12905-022-02142-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer is the commonest cancer diagnosed globally and the second leading cause of cancer-related mortality among women younger than 40 years. This study comparatively reviewed the demographic, pathologic and molecular features of Early-Onset Breast Cancer (EOBC) reported in Ghana in relation to Late Onset Breast Cancer (LOBC). METHODS A descriptive, cross-sectional design was used, with purposive sampling of retrospective histopathology data from 2019 to 2021. Reports of core or incision biopsy, Wide Local Excision or Mastectomy with or without axillary lymph node dissection specimen and matched immunohistochemistry reports were merged into a single file and analysed with SPSS v. 20.0. Descriptive statistics of frequencies and percentages were used to describe categorical variables. Cross-tabulation and chi-square test was done at a 95% confidence interval with significance established at p < 0.05. RESULTS A total of 2418 cases were included in the study with 20.2% (488 cases) being EOBCs and 79.8% (1930 cases) being LOBCs. The median age at diagnosis was 34.66 (IQR: 5.55) in the EOBC group (< 40 years) and 54.29 (IQR: 16.86) in the LOBC group (≥ 40 years). Invasive carcinoma-No Special Type was the commonest tumour type with grade III tumours being the commonest in both categories of patients. Perineural invasion was the only statistically significant pathologic parameter with age. EOBC was associated with higher DCIS component (24.8% vs 21.6%), lower hormone-receptor-positive status (52.30% vs 55.70%), higher proliferation index (Ki-67 > 20: 82.40% vs 80.30%) and a higher number of involved lymph nodes (13.80% vs 9.00%). Triple-Negative Breast cancer (26.40% vs 24.30%) was the most predominant molecular subtype of EOBC. CONCLUSION EOBCs in our setting are generally more aggressive with poorer prognostic histopathological and molecular features when compared with LOBCs. A larger study is recommended to identify the association between relevant pathological features and early onset breast cancer in Ghana. Again, further molecular and genetic studies to understand the molecular genetic drivers of the general poorer pathological features of EOBCs and its relation to patient outcome in our setting is needed.
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Affiliation(s)
- Patrick Kafui Akakpo
- grid.413081.f0000 0001 2322 8567Department of Pathology, University of Cape Coast/Cape Coast Teaching Hospital, Cape Coast, Ghana ,ACT Pathology Consult, Pedu Estate, Cape Coast, Ghana ,Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Emmanuel Gustav Imbeah
- ACT Pathology Consult, Pedu Estate, Cape Coast, Ghana ,Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Lawrence Edusei
- Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Simon Naporo
- Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Kofi Ulzen-Appiah
- grid.413081.f0000 0001 2322 8567Department of Pathology, University of Cape Coast/Cape Coast Teaching Hospital, Cape Coast, Ghana ,ACT Pathology Consult, Pedu Estate, Cape Coast, Ghana
| | - Joe Nat Clegg-Lamptey
- grid.8652.90000 0004 1937 1485Department of Surgery, University of Ghana Medical School/Korle Bu Teaching Hospital Accra, Accra, Ghana
| | - Florence Dedey
- grid.8652.90000 0004 1937 1485Department of Surgery, University of Ghana Medical School/Korle Bu Teaching Hospital Accra, Accra, Ghana
| | - Josephine Nsaful
- grid.8652.90000 0004 1937 1485Department of Surgery, University of Ghana Medical School/Korle Bu Teaching Hospital Accra, Accra, Ghana
| | - Nelson Affram
- Department of Surgery, Ho Teaching Hospital, Ho, Ghana
| | | | - Samuel Mensah
- grid.9829.a0000000109466120Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Nortey
- grid.413081.f0000 0001 2322 8567Department of Surgery, University of Cape Coast / Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Mohammed Sheriff
- grid.460777.50000 0004 0374 4427Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | - Kwabena Agbedinu
- grid.415450.10000 0004 0466 0719Department of Surgery, Komfo-Anokye Teaching Hospital, Kumasi, Ghana
| | - Evelyn Mawunyo Jiagge
- grid.446722.10000 0004 0635 5208Henry Ford Cancer Institute/Henry Ford Health System, 2799W Grand Blvd, Detroit, MI USA
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Jiagge EM, Kaljee L, Dankerlui D, Antwi S, White Perkins D, Aduse-Poku L, Ruffin W, Mills C, Fossi S, Barimah T, Daniels G, Wilson Powers E, Chue S, Waters M, Coomb C, Israel B, Brush B, Walker EM. Participatory Action for Access to Clinical Trials (PAACT): Increasing participation of blacks in Southeastern Michigan in cancer clinical trails. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18527 Background: The underrepresentation of minority populations in research violates principles of distributive justice, slows scientific progress, and exacerbates health disparities. Henry Ford Cancer Institute (HFCI) is one of 20 sites offering clinical trials in Michigan and currently participates in 1300 trials. The rate of cancer cases at HFCI is 78% in whites and 21.9% in Blacks/African Americans (B/AA). However, analysis of cancer clinical trials conducted at HFCI showed participation rates to be 2.66% in B/AA and 90.28% in whites. Diverse attempts by HFCI to improve participation of B/AA in clinical trials have yielded limited success. The Participatory Action for Access to Clinical Trials (PAACT) project is using a community-based participatory research (CBPR) approach to design/adapt, pilot, and evaluate interventions which address cancer clinical trial participation barriers among B/AA. Methods: PAACT uses a 5-step approach: 1. Establish a steering committee (SC) in partnership with the Detroit Urban Research Center, which has a strong history of implementing CBPR programs in Detroit. 2. Conduct a scoping review to evaluate evidence-based strategies and interventions used to engage B/AA communities in clinical trials. 3. Conduct qualitative and quantitative research with members of B/AA community, cancer survivors/patients, and HFCI providers. 4. Engage stakeholders in the interpretation and translation of data to inform intervention strategies. 5. Pilot the intervention(s) to assess B/AA individuals’ behavioral intentions to enroll and participate in cancer clinical trials, and health care providers’ intentions to engage in change processes. Results: We have conducted 13 SC meetings, co-facilitated by a community, academic and health system partner. The SC has been actively engaged in all aspects of the project. Through the scoping review, we identified five categories of recruitment and retention strategies. We have conducted 13 focus groups with 100 participants, 7 provider interviews, and administered 1 survey to HFCI staff. Data from the focus groups has provided information on respondents’ clinical trial knowledge and systemic, socio-cultural, and economic barriers to trial participation. Data from the provider interviews has provided information on experience with clinical trial recruitment and recommendations for improving participation among B/AA community members. Conclusions: Through CBPR, PAACT actively engages B/AA community members, survivors/patients, healthcare providers, and researchers in the process to develop/adapt, implement, and evaluate strategies to better inform communities and patients about cancer clinical trials. The long-term goal of this project is to implement changes in both the community and the health care system thereby increase levels of participation in clinical trials among B/AA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sophia Chue
- Caribbean Community Service center, Detroit, MI
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Jiagge EM, Oppong JK, Harvey K, Bensenhaver JM, Adjei E, Cheng X, Ulintz P, Gyan KK, Salem B, Kyei I, Awuah B, Wicha M, Newman LA, Merajver S. Biologic diversity of breast cancers in women with African ancestry. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Xu Cheng
- University of Michigan, Ann Arbor, MI
| | | | - Kofi K. Gyan
- Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI
| | | | | | | | - Max Wicha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Jiagge EM, Wong S, Gilani R, Luthur T, Bensenhaver J, Oppong JK, Kyei I, Adjei E, Awuah B, Li J, Carpten J, Wicha M, Newman L, Merajver S. Abstract P6-07-01: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-07-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- EM Jiagge
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - S Wong
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - R Gilani
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - T Luthur
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - J Bensenhaver
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - JK Oppong
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - I Kyei
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - E Adjei
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - B Awuah
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - J Li
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - J Carpten
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - M Wicha
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - L Newman
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - S Merajver
- University of Michigan, Ann Arbor, MI; Translational Genomic Research Institute, Phoenix, AZ; Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; Komfo Anokye Teaching Hospital, Kumasi, Ghana; University of Southern California, Keck School of Medicine, Los Angeles, CA
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Jiagge EM, Jibril A, Divine G, Gyan KK, Bensenhaver JM, Oppong JK, Awuah B, Adjei E, Merajver S, Wicha M, Newman LA. Beyond triple-negative breast cancer and African ancestry: Tumor phenotypes among internationally diverse patient populations. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1101 Background: Population-based incidence rates of breast cancers that are negative for estrogen receptor (ER), progesterone receptor (PR), and HER2/ neu(triple negative breast cancer {TNBC}) are higher among African American (AA) compared to White American (WA) women. Several studies show higher TNBC frequency among selected populations of African patients. The colonial-era trans-Atlantic slave trade resulted in shared West African ancestry between contemporary AA and Ghanaian (Gh) populations. The extent to which TNBC susceptibility is related to East African versus West African ancestry, and whether these associations extend to expression of other biomarkers such as Androgen Receptor (AR) and mammary stem cell marker ALDH1 is unknown. Methods: We used immunohistochemistry to assess ER, PR, HER2/ neu, AR and ALDH1 among WA (n = 153); AA (n = 76); Ethiopian (Eth)/East African (n = 90) and (Gh)/West African (n = 286) breast cancers through an IRB-approved international research program. Results: Mean age at breast cancer diagnosis was 43; 49; 60; and 57 years for the Eth; Gh; AA; and WA patients, respectively. Frequency of TNBC was significantly higher for AA and Gh patients (54% and 41%, respectively) compared to WA and Eth patients (23% and 15%, respectively); p < 0.001. These associations were unchanged when limited to patients age 50 and younger (47% and 49% for AA and Gh, respectively; versus 18% and 16% for WA and Eth, respectively); p < 0.001. Frequency of ALDH1 positivity was also higher for tumors from AA and Gh patients (32% and 36%, respectively) compared to those from WA and Eth patients (23% and 17%, respectively); p = 0.007. Significant differences were observed for distribution of AR positivity, which was 71%; 55%; 42% and 50% for the WA; AA; Gh; and Eth cases, respectively (p = 0.008). Conclusions: We found a correlation between extent of African ancestry and risk of particular BC phenotypes. West African ancestry was associated with increased risk of TNBC and breast cancers that are positive for ALDH1. Future studies of hereditary TNBC susceptibility among women with African ancestry are warranted.
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Affiliation(s)
| | - Aisha Jibril
- St. Paul's Hospital Millenium Medical College, Addis Ababa, Ethiopia
| | | | - Kofi K. Gyan
- Henry Ford Health System Department of Surgery, Detroit, MI
| | | | | | | | | | - Sofia Merajver
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Max Wicha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Lisa A. Newman
- Henry Ford Health System Department of Surgery, Detroit, MI
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Jiagge EM, Oppong JK, Awuah B, Newman LA, Wicha M, Merajver S. Characteristics of breast cancer in Ghana and prevalence of aggressive disease and high mortality. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Lisa A. Newman
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Max Wicha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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